Insurers have found themselves at a crossroads when it comes to genetic testing. Some cover these tests, believing they are preventable services that can help decrease further medical utilization. Others contend genetic tests are an unnecessary expense that generate ineffective treatments.
Like other decisions facing insurers, the question of whether to cover genetic tests is based on costs. U.S. spending on genetic tests is expected to grow fivefold from $5 billion in 2010 to about $25 billion in 2020, despite that most of the 1,300 available DNA tests haven't been proven effective, the Chicago Tribune reported.
One major concern regarding genetic tests is that they increase treatments that don't work or patients don't need because of how doctors apply and interpret them. Physicians may, for example, prescribe intensive cancer treatment based on a test showing a patient is at low risk.
"There's a huge proliferation of genetic tests that are not going to offset existing medical costs," said Ezekiel Emanuel, chairman of the department of medical ethics and health policy at the University of Pennsylvania. "And while some of these tests help target therapy, like in lung cancer, some of them are going to create new costs."
However, research published in the Genetics in Medicine journal contradicts those concerns, finding that patients who undergo genetic testing aren't likely to demand abnormal levels of follow-up tests or other care.
Another issue related to genetic tests is that they're often unreliable and not approved by the Food and Drug Administration, said Rita Redberg, a University of California at San Francisco cardiologist who advises WellPoint. "The labs that perform the tests are of variable quality, and it's often unclear how to use the results," she told the Tribune.
Insurers, essentially, are concerned about being sent down "blind alleys," said Reed Tuckson, UnitedHealth's executive vice president and chief of medical affairs. "That's something you wouldn't want for anyone. And it takes the costs of care through the roof."
"The amount of confusion around coverage and reimbursement for genetic testing is extraordinary," said Sharon Terry, president and chief executive of advocacy group Genetic Alliance. "Before you start advising people that they might drop dead, you want to make sure that this test is absolutely correct," she said.
To learn more:
- read the Chicago Tribune article